Post-COVID Assessment and Rehabilitation Services

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City & Hackney COVID Rehabilitation Service (City & Hackney CoRe) is a multidisciplinary service to support people with ongoing symptoms following COVID-19 infection that do not require further investigation or medical management. We aim to help people to develop skills and strategies to support recovery and lessen the impact of living with ongoing symptoms that impact on their daily function.

Treatment may include a combination of any of the following:

  • Group programmes – including an introductory session, 6-week course and standalone workshops
  • Supported use of apps and websites such as Living With COVID and Your COVID recovery
  • Signposting to community services
  • Individualised treatment with any combination of physiotherapy, psychology and occupational therapy
  • Onward referral to English National Opera Breathe Programme (ENO Breathe)

This is based at St Leonard’s (hosted by Locomotor) and runs virtually/face-to-face outpatient as required.

The first appointment is likely to be an online virtual webinar for people who have access to a smart phone, tablet or computer. If this is not suitable for your patient (i.e. non-English speaking, no digital access), please note this on the referral and our administrator can make contact and offer an individual appointment by telephone or face-to-face.

 

The Post-COVID Specialist Assessment Clinic is run by a specialist respiratory physiotherapist with support of a respiratory consultant, occupational therapy and psychology to assess ongoing symptoms following COVID-19 infection and carry out further investigations as required.

Where relevant CPTA, ECHO, ECG, bloods, exercise capacity testing and lung function may be performed and if appropriate onward referral may be made to Bart’s Health for cardiac MRI and autonomic testing.

This clinic is based at Homerton Hospital and will run virtually/face-to-face as required.

 

Resources

 


Eligibility criteria

Inclusions

  • Suspected or confirmed acute COVID-19, irrespective of whether they were hospitalised or had a positive or negative SARS‑CoV‑2 test (PCR, antigen or antibody).
  • Adults over 18 years old
  • Must have City & Hackney GP for City and Hackney CoRe referrals
  • Have had initial thorough primary care assessment in accordance with Clinical reference Guidance to exclude alternative diagnosis
  • Have had initial resources provided to support self-management. The Homerton resource pack can be found here.
  • CXR within last 4 weeks if ongoing/new breathlessness
  • Must be 12 weeks post onset of symptoms (referrals for patients 8weeks+ may be considered if indicated - please get in touch to discuss further)

Exclusions

  • Acutely unwell patients including:
    • Unexplained/new sudden onset/worsening breathlessness
    • Severe chest pain or palpitations

(please refer to City & Hackney Urgent post COVID Breathlessness Pathway to identify urgent assessment and treatment requirements)

  • Acute COVID <4 weeks
  • People who should be managed under a different speciality care pathway i.e. Respiratory/Cardiology/Rheumatology i.e. there is a clear medical diagnosis or exacerbation of existing medical condition requiring input from that speciality. Please refer to those specialities as per usual
  • Pregnancy – to be reviewed on a case by case basis.
  • Referrals for children under 18 years old

Considerations

People who would be better supported under a different rehabilitation pathway:

  • Physical and functional limitations that would be better supported by another community service like ACRT/IIT/ACN
    • Best treated in person in their own homes; or exacerbation of existing medical condition leading to deterioration in function (e.g. neuro conditions may be better supported by Neuro ACRT)
  • Pre-morbid asthma/COPD may be better served by ACERS in the first instance

How to refer

The following clinicians can refer to this service: GPs

EMIS form

Referral methods: e-Referrals

Referral for both services is via a single point of access on e-RS. The referrals will be reviewed by the team and directly booked into the relevant clinic for either Specialist Assessment or COVID Rehab as appropriate.

Referrals should be sent to the following service:

 

RAS Post-COVID Specialist Assessment & Rehabilitation Services – Homerton - RQX

To find the service, select:

Priority: Routine

Specialty: Post-COVID-19 Syndrome

Clinic Type: Post-COVID-19 Syndrome Service

Please note that the service is for patients who are 18 years+. The service will not be found if the patient is below this age. Also, we will not see the request until the referral form is attached.

Following Post-COVID Primary Care Assessment, please complete the standardised referral form embedded in EMIS. Relevant information will automatically be pulled into the form – please check the fields have been fully completed.

(For guidance to support Primary Care Assessment please see Clinical Reference Guide: Post COVID Syndrome Pathway Pan-London Guidance for Standardised Referral, Assessment and Onward Access to Rehabilitation Services). 

Please note that the information requested on the referral form is essential for the referral to be accepted and includes:

  • Clinical Assessment – including current symptoms, date of suspected/confirmed COVID-19 infection, rationale for referring to post-covid syndrome pathway

  • Investigations –

    • CXR

    • Bloods – FBC, CRP, U&Es, LFTs, Vitamin D levels, Ferritin, COVID Serology

      •  If indicated – BNP (non-respiratory associated breathlessness), Cortisol (severe fatigue) Creatine Kinase (muscle pain)

    • ECG (if chest pain/palpitations)

  • Bedside investigations:

    • Desaturation test – 1 min sit to stand test or 40 step test if not able to do a sit to stand test

    • Oxygen saturations

    • Heart rate

    • BP – lying and sitting

  • Yorkshire COVID Rehabilitation Questionnaire